Provider Demographics
NPI:1649635665
Name:DAVID, TATUM LYNNIE FRANCISCO (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TATUM LYNNIE
Middle Name:FRANCISCO
Last Name:DAVID
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:TATUM
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3215 CLEAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0409
Mailing Address - Country:US
Mailing Address - Phone:909-215-8361
Mailing Address - Fax:
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9344
Practice Address - Fax:909-421-9392
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805751163WP0808X
CA95016367363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health